1
|
Parikh SV, Aaronson ST, Mathew SJ, Alva G, DeBattista C, Kanes S, Lasser R, Bullock A, Kotecha M, Jung J, Forrestal F, Jonas J, Vera T, Leclair B, Doherty J. Efficacy and safety of zuranolone co-initiated with an antidepressant in adults with major depressive disorder: results from the phase 3 CORAL study. Neuropsychopharmacology 2024; 49:467-475. [PMID: 37875578 PMCID: PMC10724299 DOI: 10.1038/s41386-023-01751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
Major depressive disorder (MDD) is a mental health disorder that can cause disability and functional impairment that standard-of-care (SOC) antidepressant therapies (ADTs) can take weeks to treat. Zuranolone is a neuroactive steroid and positive allosteric modulator of synaptic and extrasynaptic γ-aminobutyric acid (GABA) type A receptors approved as an oral, once-daily, 14-day treatment course in adults with postpartum depression and under investigation in adults with MDD. The phase 3 CORAL Study (NCT04476030) evaluated the efficacy and safety of zuranolone 50 mg co-initiated with SOC ADT (zuranolone+ADT) vs placebo co-initiated with SOC ADT (placebo+ADT) in adults with MDD. Patients were randomized 1:1 to once-daily, blinded zuranolone+ADT or placebo+ADT for 14 days, then continued open-label SOC ADT for 28 more days. The primary endpoint was change from baseline (CFB) in the 17-item Hamilton Rating Scale for Depression (HAMD-17) total score at Day 3. Among 425 patients in the full analysis set, CFB in HAMD-17 total score at Day 3 was significantly improved with zuranolone+ADT vs placebo+ADT (least squares mean [standard error], -8.9 [0.39] vs -7.0 [0.38]; p = 0.0004). The majority of patients receiving zuranolone+ADT that experienced treatment-emergent adverse events (TEAEs) reported mild or moderate events. The most common TEAEs present in ≥10% of patients in either zuranolone+ADT or placebo+ADT groups were somnolence, dizziness, headache, and nausea. These results demonstrate that zuranolone+ADT provided more rapid improvement in depressive symptoms compared with placebo+ADT in patients with MDD, with a safety profile consistent with previous studies. Clinical trial registration: ClinicalTrials.gov identifier: NCT04476030.
Collapse
Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Scott T Aaronson
- Institute for Advanced Diagnostics and Therapeutics, Sheppard Pratt, Baltimore, MD, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Charles DeBattista
- General Psychiatry and Psychology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | - Jeff Jonas
- Sage Therapeutics, Inc., Cambridge, MA, USA
| | | | | | | |
Collapse
|
2
|
Mun S, Lee S, Yun Y, Joo EJ, Kang HG, Lee J. Serum Protein Profiling Reveals a Decrease in Apolipoprotein A-IV During a Clinical Depressive Mood State. J Inflamm Res 2023; 16:3925-3936. [PMID: 37692060 PMCID: PMC10492543 DOI: 10.2147/jir.s419176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Depressive mood is a major psychiatric symptom that causes serious disturbances in daily life. Unlike physical symptoms, psychiatric symptoms are more difficult to evaluate objectively. Therefore, we aimed to discover biomarkers that reflect changes in serum protein metabolism during a clinical depressive mood. Methods Serum protein profiling was conducted in participants who were not experiencing a current depressive episode (healthy individuals and patients in remission). Serum proteins were identified and quantified using liquid chromatography-tandem mass spectrometry. Differentially expressed proteins with a p-value <0.05 were selected, and candidate biomarkers were verified using multiple reaction monitoring analysis for absolute quantification. Results Apolipoprotein A-IV levels were lower in the group with a current episode of depression than in the remission and healthy control groups. Further, fibronectin levels were also lower in the group with a current episode of depression than in the healthy control group but not in the remission group. Conclusion We found that apolipoprotein A-IV-mediated inflammation is involved in clinical depressive moods, possibly by inducing neurological changes in the brain. Therefore, apolipoprotein A-IV and fibronectin levels may be explored as potentially novel biomarkers for detecting a current episode of depression.
Collapse
Affiliation(s)
- Sora Mun
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Gyeonggi, Republic of Korea
| | - Seungyeon Lee
- Department of Senior Healthcare, Graduate School, Eulji University, Gyeonggi, Republic of Korea
| | - Yeeun Yun
- Department of Biomedical Laboratory Science, Graduate School, Eulji University, Gyeonggi, Republic of Korea
| | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi, Republic of Korea
| | - Hee-Gyoo Kang
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Gyeonggi, Republic of Korea
- Department of Senior Healthcare, Graduate School, Eulji University, Gyeonggi, Republic of Korea
- Department of Biomedical Laboratory Science, Graduate School, Eulji University, Gyeonggi, Republic of Korea
| | - Jiyeong Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Gyeonggi, Republic of Korea
- Department of Biomedical Laboratory Science, Graduate School, Eulji University, Gyeonggi, Republic of Korea
| |
Collapse
|
3
|
Cohn J. The Detransition Rate Is Unknown. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1937-1952. [PMID: 37308601 PMCID: PMC10322769 DOI: 10.1007/s10508-023-02623-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023]
Affiliation(s)
- J Cohn
- Society for Evidence-Based Gender Medicine, Twin Falls, ID, 83301-5235, USA.
| |
Collapse
|
4
|
Belge JB, Sabbe ACF, Sabbe BGCC. An update on pharmacotherapy for recurrent depression in 2022. Expert Opin Pharmacother 2023; 24:1387-1394. [PMID: 37300545 DOI: 10.1080/14656566.2023.2223962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. AREAS COVERED Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. EXPERT OPINION Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches.
Collapse
Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Amber C F Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Edegem, Belgium
- Campus Drie Eiken, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
5
|
Kwami Edem Kukuia K, Boakye Burns F, Kofi Adutwum-Ofosu K, Appiah F, Kwabena Amponsah S, Begyinah R, Efua Koomson A, Yaw Takyi F, Amatey Tagoe T, Amoateng P. Increased BDNF and hippocampal dendritic spine density are associated with the rapid antidepressant-like effect of iron-citalopram and iron-imipramine combinations in mice. Neuroscience 2023; 519:90-106. [PMID: 36948482 DOI: 10.1016/j.neuroscience.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Iron supplementation previously demonstrated antidepressant-like effects in post-partum rats. The present study evaluates the possible synergistic antidepressant effect of sub-therapeutic dose of iron co-administered with citalopram or imipramine in female Institute of Cancer Research mice. Depression-like symptoms were induced in the forced swim (FST), tail suspension (TST), and open space swim (OSST) tests while open field test (OFT) was used to assess locomotor activity. Mice (n=8) received iron (0.8- 7.2 mg/kg), citalopram (3-30 mg/kg), imipramine (3-30 mg/kg), desferrioxamine (50 mg/kg) or saline in the single treatment phase of each model and subsequently a sub-therapeutic dose of iron co-administered with citalopram or imipramine. Assessment of serum BDNF and dendritic spine density was done using ELISA and Golgi staining techniques respectively. Iron, citalopram and imipramine, unlike desferrioxamine, reduced immobility score in the TST, FST and OSST without affecting locomotor activity, suggesting antidepressant-like effect. Sub-therapeutic dose of iron in combination with citalopram or imipramine further enhanced the antidepressant-like effect, producing a more rapid effect when compared to the iron, citalopram or imipramine alone. Iron, citalopram and imipramine or their combinations increased serum BDNF concentration, hippocampal neuronal count and dendritic spine densities. Our study provides experimental evidence that iron has antidepressant-like effect and sub-therapeutic dose of iron combined with citalopram or imipramine produces more rapid antidepressant-like effect. We further show that iron alone or its combination with citalopram or imipramine attenuates the neuronal loss associated with depressive conditions, increases dendritic spines density and BDNF levels. These finding suggest iron-induced neuronal plasticity in the mice brain.
Collapse
Affiliation(s)
- Kennedy Kwami Edem Kukuia
- Department of Medical Pharmacology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana.
| | - Frederick Boakye Burns
- Department of Pharmacology & Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O Box LG 43, Legon, Accra, Ghana.
| | - Kevin Kofi Adutwum-Ofosu
- Department of Anatomy, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Frimpong Appiah
- Department of Community Health and Medicine, School of Food and Health Sciences, Anglican University College of Technology, Nkoranza, Ghana.
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana.
| | - Richard Begyinah
- Department of Pharmacology & Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O Box LG 43, Legon, Accra, Ghana.
| | - Awo Efua Koomson
- Department of Medical Pharmacology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana.
| | - Ferka Yaw Takyi
- Department of Pharmacology & Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O Box LG 43, Legon, Accra, Ghana.
| | - Thomas Amatey Tagoe
- Department of Physiology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana.
| | - Patrick Amoateng
- Department of Pharmacology & Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O Box LG 43, Legon, Accra, Ghana.
| |
Collapse
|
6
|
All-Solid-State Potentiometric Platforms Modified with a Multi-Walled Carbon Nanotubes for Fluoxetine Determination. MEMBRANES 2022; 12:membranes12050446. [PMID: 35629772 PMCID: PMC9144631 DOI: 10.3390/membranes12050446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/25/2023]
Abstract
Novel cost-effective screen-printed potentiometric platforms for simple, fast, and accurate assessment of Fluoxetine (FLX) were designed and characterized. The potentiometric platforms integrate both the FLX sensor and the reference Ag/AgCl electrode. The sensors were based on the use of 4′-nitrobenzo-15-crown-5 (ionophore I), dibenzo-18-crown-6 (ionophore II), and 2-hydroxypropyl-β-cyclodextrin (2-HP-β-CD) (ionophore III) as neutral carriers within a plasticized PVC matrix. Multiwalled carbon nanotubes (MWCNTs) were used as a lipophilic ion-to-electron transducing material and sodium tetrakis [3,5-bis(trifluoromethyl)phenyl] borate (NaTFPB) was used as an anionic excluder. The presented platforms revealed near-Nernstian potentiometric response with slopes of 56.2 ± 0.8, 56.3 ± 1.7 and 64.4 ± 0.2 mV/decade and detection limits of 5.2 × 10−6, 4.7 × 10−6 and 2.0 × 10−7 M in 10 mM Tris buffer solution, pH 7 for sensors based on ionophore I, II, and III, respectively. All measurements were carried out in 10 mM tris buffer solution at pH 7.0. The interfacial capacitance before and after insertion of the MWCNTs layer was evaluated for the presented sensors using the reverse-current chronopotentiometry. The sensors were introduced for successful determination of FLX drug in different pharmaceutical dosage forms. The results were compared with those obtained by the standard HPLC method. Recovery values were calculated after spiking fixed concentrations of FLX in different serum samples. The presented platforms can be potentially manufacturable at large scales and provide a portable, rapid, disposable, and cost-effective analytical tool for measuring FLX.
Collapse
|
7
|
Ahmad I, Ullah Z, Khan MI, Alahmari AK, Khan MF. Development and validation of an automated solid-phase extraction-LC-MS/MS method for the bioanalysis of fluoxetine in human plasma. J Adv Pharm Technol Res 2021; 12:267-273. [PMID: 34345606 PMCID: PMC8300324 DOI: 10.4103/japtr.japtr_308_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
A wide-range, specific, and precise liquid chromatography tandem mass spectrometric (LC-MS/MS)technique for quantifying fluoxetine (FLX) in human plasma was developed using the RapidTrace® automated solid-phase extraction (SPE) method; the analyte and internal standard (IS) were extricated on Oasis MCX SPE cartridges. Acetonitrile and 5 mM ammonium formate buffer (90:10 v/v) were used as mobile phase to achieve chromatographic separation on the reverse phase (C18 column). The analyte and IS were ionized using +ve electrospray ionization approach which was further traced by multiple-reaction monitoring on a tandem mass spectrometer. To quantify the FLX and FLX-d5, the parent-to-daughter ion transition of m/z of 310.0/44.1 and 315.0/44.0 was used, respectively. The method demonstrated a linear active limit of 0.20-30 ng/ml with recoveries ranging from 63.04% to 79.39% for quality control samples and 61.25% for IS samples. The concentrations over the calibration range demonstrated acceptable precision and accuracy. Due to the high inconsistency of the FLX concentration data, the minimum threshold of the assay was kept at 0.20 ng/ml. The flow rate was maintained at 500 μL/min, and the time for sample analysis for each injection was 3.5 min. The method was found to be specific, sensitive, and faster with minimum utilization of organic solvents and was utilized further for metabolic and pharmacokinetic studies.
Collapse
Affiliation(s)
- Ishtiaque Ahmad
- Scientific Research Center, Prince Sultan Military Medical City, Al-Kharj, Riyadh, Saudi Arabia
| | - Zabih Ullah
- Department of Pharmaceutical Sciences, College of Pharmacy and Dentistry, Buraydah Colleges, Alqassim, Saudi Arabia
| | - Mohd Ibrahim Khan
- Department of Pharmaceutical, Sciences SIHAS, Sam Higginbottom, University of Agriculture Technology and Sciences, Naini, Prayagraj, India
| | - Abdullah Khaloofa Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Mohd Faiyaz Khan
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Greden JF, DePaulo JR. NNDC Special Issue: Challenges of Mood Disorders Care. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:87. [PMID: 33162845 DOI: 10.1176/appi.focus.20200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John F Greden
- Department of Psychiatry and Comprehensive Depression Center, University of Michigan, Ann Arbor (Greden); Hopkins Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (DePaulo). The authors are founding chair and chair, respectively, of the National Network of Depression Centers, Ann Arbor
| | - J Raymond DePaulo
- Department of Psychiatry and Comprehensive Depression Center, University of Michigan, Ann Arbor (Greden); Hopkins Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (DePaulo). The authors are founding chair and chair, respectively, of the National Network of Depression Centers, Ann Arbor
| |
Collapse
|